Pain and its cognitive effects

by Anthony Cole

I told the first pain specialist I saw that I can cope with the pain itself, but asked "Can anything be done about the cognitive effects of chronic pain?" He actually laughed and said "And what might they be?" I had done a little Googling and handed him a list of what I had found. (I think it included working memory and attention deficits) His smile faded and he said "We address the pain here." After that he refused to engage in any discussion about the cognitive effects of pain and, as soon as possible, shoved me off onto his trainee.

I now have a new specialist - an eminent professor. He, too, knows nothing about the effect of pain on cognition and frankly admits it's not his field and he's not very interested, but he is patient and listens.

I find this indifference of the two most eminent pain specialists in Western Australia mind boggling. Because, for me, pain's impact on concentration, working memory, self control and social sensitivity is the most disabling aspect of the phenomenon. It is these cognitive faculties plus language that distinguish you from an orangutan.

But it is not only the clinicians who are indifferent. The research community is no better. If you Google the psychological effects of pain you will find quite a bit on depression and anxiety and that's about all: almost nothing about the irritability that plagues many sufferers; a few excellent scraps about working memory and attention; nothing about emotion regulation and impulse inhibition; and nothing about the effect that chronic physical pain might have on our experience of other important feelings like social pain.

I have started reviewing the peer-reviewed literature containing both terms "pain" and "cognition" from 1960 to the present and am half-way through sorting the different papers into categories (1500 out of 3000 documents - slim pickings so far). It might be a while yet (it's bloody tedious), but worth doing, I think.

By the way, there are several drugs that help with the cognitive deficits caused by homeostatic emotions like pain. But to the best of my knowledge they have not been clinically trialled on pain - because nobody is taking the cognitive effects of pain seriously. They have been thoroughly trialled on sleep deprivation though (for the US military); and the patent has expired on some, so they're available as cheaper generics - I spend $3.30 per day on them. If my first specialist had been able to tell me that, the last six years might have been very, very different indeed.

Very short story: The quartz pebble

You are walking with a friend discussing a popular poet. A tiny quartz pebble has found its way into your shoe and is now directly under your heel, but your friend is about to sum up and you don't want to interrupt the flow of the conversation, so you continue walking, looking interested. Stab. Stab. Stab. Soon she smiles broadly and says, "Well what do you think?" But you think nothing. You have lost the thread. You determine to attend to her with all your might and, as sensitively as possible, ask if she couldn't rephrase what she just said. Stab. Stab. Stab. Something flits across her face. Was it irritation? Contempt? The glance is like the twist of a sword in your heart. She begins again and, not smiling, her eyes scan you. The sword twists again. She flinches at your grimacing attempted smile. Twist. On you trudge. Stab. Stab. Stab. Oblivious to your surroundings, you try to think back about the poem and what she's been saying but can only grasp disconnected fragments. Stab. Stab. Stab. She looks at you to see if you're following and nods to affirm a point. Should you nod too? Was that a frown? Twist. Stab. Stab. Sitting on a bolder, you remove your shoe and shake out the very tiny quartz pebble which pings off the bolder and disappears into the sand, and replace your shoe. In the peachy sky behind your friend the huge orange sun hangs just above the horizon, tracing a gold outline on her cheek. The smell of horses fills the warm, still air and, a mile away, a bull frog is croaking. Her insight washes through the poem; cutting a new, deep, elegant pattern of meaning and you laugh and say, "Of course! I thought I knew that poem so well. How could I have missed that?" She smiles and blushes; you blush and smile. Now you're both smiling at the fact that you're both blushing. She takes your hand and pretends to pull you up from the bolder, and you walk on in silence for a while, feeling perfect.

Sometimes the journey TAKES YOU TO A PLACE UNMAPPED. Anything is possible